Pratt Keeley J, Miller Harvey J, Hanks Andrew S, Focht Brian C, Noria Sabrena, Brethauer Stacy, Needleman Bradley
Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, 1787 Neil Ave, Columbus, OH, 43210, USA.
Department of General Surgery, College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA.
Obes Surg. 2024 Jan;34(1):114-122. doi: 10.1007/s11695-023-06906-7. Epub 2023 Nov 28.
Transportation, access to follow-up care, and association with weight loss are understudied in the bariatric population. The objective of this study was to determine how transportation variables associate with postoperative attendance and weight loss through 24 months.
Seven hundred eighty-seven patients (81.3% female; 59.1% White) who had primary surgery (48.6% gastric bypass) from 2015 to 2019 were included. Sidewalk coverage and number of bus stops from patients' homes, driving distance in miles and minutes from patients' homes to the nearest bus stop and the clinic were measured. Bivariate analyses were conducted with the transportation variables and attendance and %TWL at 2 or 3, 6, 12, and 24 months. One mixed multilevel model was conducted with dependent variable %TWL over 24 months with visits as the between-subjects factor and covariates: race, insurance, surgical procedure, and driving distance to the clinic in minutes, attendance, and %TWL over 24 months; an interaction between distance, attendance, and visits.
There were no significant differences between the majority of the transportation variables and postoperative attendance or %TWL. Patients who had perfect attendance had improved %TWL at 12 months [t(534)=-1.92, p=0.056] and 24 months [t(393)=-2.69, p=0.008] compared to those who missed at least one appointment. Patients with perfect attendance and who had shorter driving times (under 20 min) to the clinic had greater weight loss through 24 months [F(10, 1607.50)=2.19, p=0.016)].
Overall, transportation factors were not associated with attendance and weight loss, with the exception of the interaction between shorter driving minutes to follow-up and perfect attendance.
在肥胖症患者群体中，对交通出行、后续护理的可及性以及与体重减轻的关联研究较少。本研究的目的是确定交通变量如何与术后24个月的就诊情况和体重减轻相关联。
纳入了2015年至2019年接受初次手术（48.6%为胃旁路手术）的787例患者（81.3%为女性；59.1%为白人）。测量了患者家附近的人行道覆盖率和公交站点数量、从患者家到最近公交站点以及诊所的驾车距离（以英里和分钟为单位）。对交通变量与2个月或3个月、6个月、12个月和24个月时的就诊情况及体重减轻百分比（%TWL）进行了双变量分析。进行了一个混合多水平模型，以24个月内的%TWL作为因变量，就诊次数作为组间因素，并纳入协变量：种族、保险类型、手术方式、到诊所的驾车时间（以分钟为单位）、就诊情况以及24个月内的%TWL；距离、就诊情况和就诊次数之间的交互作用。
大多数交通变量与术后就诊情况或%TWL之间无显著差异。与至少错过一次预约的患者相比，全勤患者在12个月时的%TWL有所改善[t(534)= -1.92，p = 0.056]，在24个月时也有所改善[t(393)= -2.69，p = 0.008]。全勤且到诊所驾车时间较短（20分钟以内）的患者在24个月内体重减轻更多[F(10, 1607.50)= 2.19，p = 0.016]。
总体而言，除了较短的随访驾车时间与全勤之间的交互作用外，交通因素与就诊情况和体重减轻无关。
